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Objectives To determine functional and psychological benefits of a 12 week supervised group exercise programme during treatment for early stage breast cancer, with six month follow-up. Design Pragmatic randomised controlled prospective open trial. Setting Three National Health Service oncology clinics in Scotland and community exercise facilities. Participants 203 women entered the study; 177 completed the six month follow-up. Interventions Supervised 12 week group exercise programme in addition to usual care, compared with usual care. Main outcome measures Functional assessment of cancer therapy (FACT) questionnaire, Beck depression inventory, positive and negative affect scale, body mass index, seven day recall of physical activity, 12 minute walk test, and assessment of shoulder mobility.Results Mixed effects models with adjustment for baseline values, study site, treatment at baseline, and age gave intervention effect estimates (intervention minus control) at 12 weeks of 129 (95% confidence interval 83 to 176) for metres walked in 12 minutes, 182 (75 to 289) for minutes of moderate intensity activity reported in a week, 2.6 (1.6 to 3.7) for shoulder mobility, 2.5 (1.0 to 3.9) for breast cancer specific subscale of quality of life, and 4.0 (1.8 to 6.3) for positive mood. No significant effect was seen for general quality of life (FACT-G), which was the primary outcome. At the six month follow-up, most of these effects were maintained and an intervention effect for breast cancer specific quality of life emerged. No adverse effects were noted. Conclusion Supervised group exercise provided functional and psychological benefit after a 12 week intervention and six months later. Clinicians should encourage activity for their patients. Policy makers should consider the inclusion of exercise opportunities in cancer rehabilitation services. Trial registration Current controlled trials ISRCTN12587864.

Many contemporary studies of 'work-life balance' either ignore gender or take it for granted. We conducted semi-structured interviews with men and women in mid-life (aged 50 to 52 years) in order to compare their experiences of work-life balance. Our data suggest that gender remains embedded in the ways that respondents negotiate home and work life. The women discussed their current problems juggling a variety of roles (despite having no young children at home), while men confined their discussion of such conflicts to the past, when their children were young. However, diversity among men (some of whom 'worked to live' while others 'lived to work') and women (some of whom constructed themselves in relation to their families, while others positioned themselves as 'independent women') was apparent, as were some commonalities between men and women (both men and women constructed themselves as 'pragmatic workers'). We suggest ways in which gender-neutral theories of work-life balance may be extended.

Appraising qualitative research depends on the transparency with which the research process is described. Awareness of professional background is particularly important for university departments of primary care (which often include doctors, nurses and social scientists) and should be considered carefully in designing, carrying out and disseminating the results of qualitative studies.

There is evidence that physical activity improves the psychological and physical health of patients with cancer. However, relatively little attention has been paid to understanding their experiences of exercise. This focus group study explored the experiences of women undergoing treatment for breast cancer who had taken part in a supervised group exercise trial. We found that setting up classes solely for women with breast cancer, led by an expert instructor, helped to reduce gender-related barriers to physical activity, such as difficulties in prioritizing exercise over caring roles and worries about changed appearance. For example, some women challenged traditional expectations of femininity by removing their wigs in the classes in order to exercise in comfort. Respondents valued exercising with women in the 'same boat' because of the empathy and acceptance they received and the opportunities to exchange information and form friendships. However, the action-orientated format of the group was preferred to a talk-based format such as a support group; some respondents felt that the 'last thing' they wished to do was to talk about cancer. Our findings therefore challenge stereotypes about women invariably preferring to cope with cancer through emotional disclosure.

Most qualitative research on alcohol focuses on younger rather than older adults. To explore older people’s relationship with alcohol, we conducted eight focus groups with 36 men and women aged 35 to 50 years in Scotland, UK. Initially, respondents suggested that older drinkers consume less alcohol, no longer drink to become drunk and are sociable drinkers more interested in the taste than the effects of alcohol. However, as discussions progressed, respondents collectively recounted recent drunken escapades, challenged accounts of moderate drinking, and suggested there was still peer pressure to drink. Some described how their drinking had increased in mid-life but worked hard discursively to emphasise that it was age and stage appropriate (i.e. they still met their responsibilities as workers and parents). Women presented themselves as staying in control of their drinking while men described going out with the intention of getting drunk (although still claiming to meet their responsibilities). While women experienced peer pressure to drink, they seemed to have more options for socialising without alcohol than did men. Choosing not to drink alcohol is a behaviour that still requires explanation in early mid-life. Harm reduction strategies should pay more attention to drinking in this age group.

BackgroundGypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, it is necessary to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims.Investigate the views of Travellers in the UK on the barriers and facilitators to acceptability and uptake of immunisations and explore their ideas for improving immunisation uptake;Examine whether and how these responses vary across and within communities, and for different vaccines (childhood and adult). MethodsThis was a qualitative, cross-sectional interview study informed by the Social Ecological Model. Semi-structured interviews were conducted with 174 Travellers from six communities: Romanian Roma, English Gypsy/Irish Travellers (Bristol), English Gypsy (York), Romanian/Slovakian Roma, Scottish Show people (Glasgow) and Irish Traveller (London). The focus was childhood and selected adult vaccines. Data were analysed using the Framework approach.ResultsCommon accounts of barriers and facilitators were identified across all six Traveller communities, similar to those documented for the general population. All Roma communities experienced additional barriers of language and being in a new country. Men and women described similar barriers and facilitators although women spoke more of discrimination and low literacy. There was broad acceptance of childhood and adult immunisation across and within communities, with current parents perceived as more positive than their elders. A minority of English-speaking Travellers worried about multiple/combined childhood vaccines, adult flu and whooping cough and described barriers to booking and attending immunisation. Cultural concerns about antenatal vaccines and HPV vaccination were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified as barriers across different communities. Trustful relationships with health professionals were important and continuity of care valued.ConclusionsThe experience of many Travellers in this study, and the context through which they make health decisions, is changing. This large study identified key issues that should be considered when taking action to improve uptake of immunisations in Traveller families and reduce the persistent inequalities in coverage.Trial registrationCurrent Controlled Trials ISRCTN20019630.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4178-y) contains supplementary material, which is available to authorized users.

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